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  • My experience as an agency nurse

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    Summary

    In this blog, Martin Hogan shares his experience of working as an agency nurse and how different behaviours can impact on the safety of both staff and patients.  

    Content

    Six months ago, I left my band 7 managerial role to work as a band 5 agency nurse on the wards. Despite the band drop, this move has financial advantages which will help me to achieve some personal goals. 

    Signing up

    After successfully completing the recruitment process, I am asked to attend mandatory training. This includes basic life support, manual handling and infection control. The usual, run of the mill stuff.

    I can book shifts a week or a day in advance, but these shifts can change to any speciality or department in the hospital, depending on staffing levels. I book my first shift after six years of having not worked within a ward setting.

    An unsafe start

    I turn up to the shift and introduce myself to be met with a mutter.

    The team and I receive handover and I am allocated my bay of patients. I notice I have twelve patients, three more than the other nurses. I reiterate this is my first time here and that I haven’t worked in ward work for some years. I ask if it would it be possible for someone to show me around – resuscitations trolley, toilets, codes to the drug cupboards. General housekeeping. 

    I receive a grunt and a point, followed by some numbers hurled at me, along with keys. Ok, perhaps they’re just not morning people. I will give them the benefit of the doubt.

    Off I go to introduce myself to my patients and to immediately make use of my prioritisation skills, escalating any concerns I have to the seemingly disengaged shift leader and (more helpful) doctors.

    I find that my patients are acutely unwell and in need of a lot of care. I have to remind myself of my 13 years’ experience and how good I am at communicating, reassuring myself I will be ok.

    Hours later and still no toilet break

    Seven hours later, hungry and in need of a wee, I ask my shift leader if she could cover me so I can take a break. I am met with, ”your patients are too unwell for you to leave them for 15 minutes, and I don’t have the staff to cover you”. Followed by the ultimate toxic saying within the NHS, ”that’s just how we do it here, always have”. I start to feel neglectful that I would even have thought to have a drink and pass urine. 

    Ten hours pass and still I haven’t had any water or a wee. Three emergencies have taken place without me even having had a proper induction.

    I take solace in my bond with my patients and lovely doctors who understand how it feels to be isolated and new to an area.

    Speaking up

    Perhaps out of dehydration and kidney shut down, I find the voice to politely approach the other nurses and shift leader. I explain that my patients are now stable and highlight my own personal fluid needs. I mention that I still haven’t received an induction. No one has asked me my skills or background nor if I know how to use the different IT systems (drug charts are now on computers). 

    Again, I am met with, “well you choose to be agency, we just all get on with it here”.

    These are words that frighten me. It isn’t safe to get on with it. I felt out of my depth, overwhelmed, deprived of basic human rights and unwell.

    Losing confidence

    Then, a patient’s relative approaches me to say, ”I didn’t want to trouble you as you were running around looking so busy, but dad has chest pain”.

    At that point my heart breaks. How have I given the impression that I am the unapproachable one on this ward? Have I neglected this poor man? The same man who had cried with laughter at a joke I had made about some TV show we both watched the night before while I was catheterising him.

    Protocol follows and I investigate his chest pain. No acute cause. Phew. I still leave his side feeling that I am terrible at this.

    The end of my shift approaches, still no break, still no water or food. Handover time…

    I introduce myself to the night team. Finally, someone kind welcomes me to the ward. They tell me they all feel like they are doing a bad job and not giving satisfactory care. I think they are trying to reassure me. I cycle home in tears; shattered and broken.

    The next day I have serious doubts about my own ability. I call my agency and have a long chat with my recruitment consultant (who has never set foot inside a hospital and works on commission). His response?  ”Well, you don’t have to go back”.

    I start to have serious doubts about my choice to work in this way and feel even more perplexed that our wards and teams have become like this. 

    What a difference a day makes

    My next shift is in an emergency department. Dreading it, I don’t sleep the night before and I turn up riddled with anxiety about what is to fall upon me. I meet the team and prep myself to ‘kill them with kindness’.            

    Everyone is pleasant and welcoming. The senior nurse asks me about my skills and mandatory training and shows me around. She informs me of their expectations and what I could, in return, expect of her team. 

    It seems so simple, a five-minute job, huddling with your team for the sake of patient safety. But what a huge impact it has on my shift. My patients are more acute, I am busier and still don’t urinate. But I am supported and able to escalate concerns without being gas-lighted.

    Final thoughts

    I have now booked all of my shifts on that busy emergency department, simply because of the manager. I respect her management style and her approach to the safety of her unit. She doesn’t use those unhelpful and unsafe words, ”we just get on with it” or ”that’s how we do it here”.

    Since becoming a bit more settled in this world of agency nursing, I have spoken with matrons and lead directorate nurses within this trust about my experience. Often met with, ”what can I do about that?”. But sometimes met with, ”I will look into how that particular ward manages staff safety”. The latter leads on to better patient safety. 

    Key learning points

    • Inductions to new staff in new areas, should be mandatory.
    • It should be the nurse in charge's duty to support junior staff. Doing safety rounds and checking in on all staff would help to manage workload, support flow and build confidence and reassurance among staff on duty.
    • Safety huddles at the beginning, middle and sometimes end of each shift are a simple way of combating so many of the patient safety issues raised in this account. 
    • Early warning scores should be displayed and visible for all professionals on duty. They should be checked regularly and actioned accordingly.

    About the Author

    Working as a full-time agency nurse within the South, after 13 years’ experience as a nurse in various roles and bandings. I have found my experience thus far to be a huge learning curve, the good, the bad and the ugly.

    2 reactions so far

    6 Comments

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    i look forward to hearing your thoughts of my blog and would be very interested to here other people’s experience, with locuming and agency work. What works well/ not so well?

     

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    Hi @Martin Hogan  that has really scared me.  I haven't done agency work, now i have read this, I'm not sure I ever will.  The ward you worked on sounds as if there is a disaster waiting to happen.

    As an agency nurse how empowered are you to speak up?  As an agency nurse are you able to use the FTSUG (freedom to speak up guardian) at that Trust if you are not an actual member of that Trust?

    I wonder if patients realise the risk that transient staff pose if they haven't had appropriate induction.

     

    Thanks so much for posting..... I look forward to hearing more

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    Thank you. Yes it scared me too.

    I did feedback to my agency who were very supportive and like you advised me to get in contact with matron and guardian. Which I did. However this was in my own/unpaid time. ( which I think would put a lot of agency nurses off doing so)

    patients I think are at risk with transient staff. Though the wards are only in need of transient staff if staff shortages. These staff shortages are due to retention, unpleasant work environment, national shortages of nurses. Lack of development.

    so potentially rentention and staff happiness  is also a very important part of safety

     

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    What a truly worrying account of working within the ward on an agency basis.  

    Whats more concerning is that you showed interest in completing a basic orientation and in gaining further information relevant to your role that day and were still met with a brick wall from the staff on duty.

    I have never worked agency for this exact concern and again now probably never will.  Clearly, any nurse would wish to have a basic idea of of the skills that those working around them have with regard to patient care and also, having an experienced agency nurse is worth their weight in gold.  

    Though I also have not worked within an acute trust ward for some time, I would be mortified if someone made these concerns to me with regard to working anywhere within my organisation, especially if I was within a management position such as ward matron as you discussed - very worrying indeed.

    Where's your knowledge of the NMC Code ward?  Where's your compassion to each other?  Where's your concerns for patient safety?  

    My concern also lies with those who are mentors, are they enabling student nurses, physio's, OT's to work in this sort of environment?  If so where will this lead the future of the nursing workforce.

    Well done for struggling through even in this terrible situation and getting to the end of the shift with your patients all well and stable, I am sure the patient's and their relatives would be mortified to hear of staff being subject to these sort of working conditions and I believe a discussion with the ward in question is the least the management could do as they are lucky you've been so willing to adapt and try to speak up.

     

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    Thank you.yes all valied points you make there. I have found since feeding back to matrons and  people in charge that they have been responsive on the most part. The hardest bit is that they inform me we can’t change people’s personalities. Which of course I am aware of. But this i regarding professionalism and safety so a standard of practise should be meant.  I have highlighted to the managers that when staff sign my form,it states they have to sign they have inducted me, for this shift I would not let it be signed and have raised concerns that have been listened to by my agency. Who have been wonderful. I think these experiences shouldn’t put people off agency but i understand why it does.

    perhaps bank nursing is the way forward to obtain safer environment. Sort of home grown staff, who are Fimiliar with trust etc.

     

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